Provider Demographics
NPI:1336856509
Name:SEPULVEDA, KATIA
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 RED ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9002
Mailing Address - Country:US
Mailing Address - Phone:209-818-3967
Mailing Address - Fax:
Practice Address - Street 1:448 RED ROBIN DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9002
Practice Address - Country:US
Practice Address - Phone:209-818-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst